You can outsource just about any work to India these days, including making babies. Reproductive tourism in India is now a half-a-billion-dollar-a-year industry, with surrogacy services offered in 350 clinics across the country since it was legalized in 2002. The primary appeal of India is that it is cheap, hardly regulated, and relatively safe. Surrogacy can cost up to $100,000 in the United States, while many Indian clinics charge $22,000 or less. Very few questions are asked. Same-sex couples, single parents and even busy women who just don't have time to give birth are welcomed by doctors. As a bonus, many Indians speak English and Indian surrogate mothers are less likely to use illegal drugs. Plus medical standards in private hospitals are very high (not all good Indian doctors left in the brain drain).
Some describe this as a win-win situation. The doctors get clients, the childless get children and the surrogates get much-needed money. But some media horror stories have challenged this happy vision. In 2007 the Japanese couple Ikufumi and Yuki Yamada came to visit India's "Surrogacy Queen," Dr. Nayna Patel, founder of the Akanksha Infertility Clinic. A donor egg and surrogate mother was found and the embryo was implanted in the surrogate's womb. Before the child was born, however, the Yamadas divorced and Mrs. Yamada no longer wanted the child, which was not biologically hers. Mr. Yamada wanted the baby but could not adopt it due to an Indian colonial-era law that forbids single men from adopting girls. The absence of regulation meant that Baby Manji became India's first"surrogate orphan" until the father was finally able to adopt her several months, after the Supreme Court intervened. Other cases like the Japanese one have followed, involving Israeli, French, and German citizens.
The most shocking stories, however, concern the surrogate mothers. The surrogates, many of whom are cooped up in "surrogacy homes" away from their families for the duration of the pregnancy, are often in dire financial straits. One woman told a journalist that with a $4,000 debt and an alcoholic husband, she had first considered selling a kidney to get herself out of debt, but decided that the $ 7,000 surrogacy fee was the better option. In another disturbing case, an upper-class Indian woman hired a surrogate to carry her child and invited her to live in her home during the pregnancy. The client accused the surrogate mother of stealing and not only kicked her out of the house but coolly informed her that she didn't want her services anymore and that she should terminate the pregnancy. Surrogates get paid only on delivery of the baby, so this kind of situation is economically devastating for a surrogate. It can also severely compromise the ethical and religious beliefs of surrogates who may not wish to undergo an abortion.
Last year, the government began looking to regulate the industry. An Assisted Reproductive Technology Bill is up for discussion in the next parliamentary session, causing renewed interest in the ethical issues. "Surrogacy—Exploiting the Poor?" was one theme of a very popular, Oprah Winfrey-esque talk show on India's NDTV channel. One academic, professor Mohan Rao, who teaches at the prestigious Jawaharlal Nehru University, said that the country was witnessing "reproductive trafficking," referring to the fact that most cash-strapped surrogate mothers are from rural India and travel to metropolitan centers to offer their services as a last-ditch effort to get money. This view is fiercely challenged by those who see surrogacy as a means to economic empowerment of women and as a decision women should be free to make for themselves.
But the usual empowerment vs. exploitation debate eludes something much more fundamental that the surrogate industry reflects about India. India has leap-frogged several stages of development and zoomed straight into a service economy. Indians stock call centers and tech help lines where Westerners can get their questions answered efficiently. In these centers, Indian youths temporarily adopt new personal identities by using Western names and accents—another, milder way that Indians act as "surrogates," or substitutes for Westerners. The country is romanced by the idea of selling human capital as its next great commodity. So surrogacy resonates not as an old problem of exploiting the poor but as an inevitable part of the "new India," where the locals provide much needed services for the new global economy. This kind of forward-thinking economic liberation dovetails with an ideology of personal freedom. "I think women should be free to choose what they do with their bodies," says Dr. Aniruddha Malpani, a fertility specialist in Mumbai. "We shouldn't treat them as stupid just because they are poor."
This appeal to modern ideals of self-determination make sense to members of the "new India" like Dr. Malpani and his clients. The problem is that the surrogates are not members of this India. Alan Greenspan writes that "India is fast becoming two entities: a rising kernel of world-class modernity within a historic culture that has been for the most part stagnating for generations." The surrogates tend to hail from this "historic culture," which is essentially semi-feudal and pre-industrial. It is this gap that allows for exploitation in surrogacy and other industries to happen, and it is the gap—not surrogacy itself—that is the root of the problem.
To exercise one's freedom meaningfully requires information and education, and many surrogates are deeply ignorant about what the procedure entails. It is not uncommon for surrogates to authorize contracts with a thumbprint as opposed to a signature because they are illiterate. Even those who are literate often aren't able to read the contracts, which tend to be written in English. Lack of technological understanding among rural Indians also breeds misconceptions about surrogacy. Many, for example, thought that it would be necessary to sleep with another man in order to conceive. Even the pricing structure of surrogacy perpetuates social inequality: Many religious Indian surrogacy clients would prefer for their child to be birthed by an upper-caste brahmin, so high-born surrogates can get paid up to double.
These problems are hardly going to stop the phenomena of surrogacy in India from spreading, though. In fact, one might even suggest that India is moving towards a surrogacy-based economy, in which Indians—in call centers and fertility clinics alike—specialize in substituting Westerners in a cheaper, more efficient way.
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